NSG 326 Day 2 - Chapters 2, 3, mental status exam

Transference

Patient projecting something onto you

• Feelings or past relationships

Countertransference

You projecting something onto the patient

• Feelings or past relationships

Biofeedback

Trying to get the patient back to homeostasis. Non pharmacological

Modeling

Showing the patient how you want them to behave

Cognitive behavioral therapy

Test distorted beliefs and change way of thinking, reduce symptoms

Dialectical Behavioral Therapy

• Modified CBT that incorporates mindfulness

• Develop healthy ways to cope with stress, to teach people how to live in the moment, regulate emotions, improve their relationships

• Originally developed to treat borderline personality disorder, but works well with many other mental health disorders as well

Electroconvulsive therapy (ECT)

• Controlled seizures in patients

• Used to target specific brainwaves

• Only after other failed treatments and medications

Behavioral Therapy

• Modeling

• Operant conditioning

• Systematic desensitization

• Aversion therapy

• Biofeedback

Cognitive theory and therapies

• Thoughts come before feelings and actions

• Interplay between individuals and the environment

Anti-anxiety Agents purpose

To alleviate symptoms associated with anxiety or panic

• Treatment of anxiety disorders, anxiety symptoms, alcohol withdrawal, skeletal muscle spasms, convulsive disorders, status epilepticus, and preoperative sedation

• Benzodiazepines are the most commonly used group

• Buspar and Buspirone are also used, but are not benzodiazepines

Benzodiazepines

• CNS depressants, have potential for physical and psychological dependence

• Most commonly used group of anti-anxiety medications

• Should not be discontinued abruptly following long-term use because they can cause life-threatening withdrawal syndrome

• Not meant to be used forever

• Typically used as as-needed medications

• Side effects: drowsiness, confusion, and lethargy

Buspar/Buspirone

• Anti-anxiety medication that is not a benzodiazepine

• Acts as a partial serotonin receptor agonist

• Those taking buspar should not eat grapefruit or drink grapefruit juice because it affects absorption

Anti-depressants purpose

Elevate mood and alleviate other symptoms associated with moderate-to-severe depression

• Used to treat major depressive disorder, dysthymia, alcoholism, schizophrenia, depressive phase of bipolar disorder, and depression combined by anxiety

• Selected agents are also used to treat anxiety disorders, bulimia nervosa, obsessive-compulsive disorder, PTSD, and premenstrual dysphoric disorder

• Work to increase the concentration of norepinephrine and serotonin and/or dopamine in the body

Antidepressant side effects and nursing considerations

• Patient will not immediately feel effects, medications may take 4-6 weeks to produce the desired effect, but can sometimes take longer

• Side effects: The most common are anticholinergic effects (sedation and orthostatic hypotension). Weight gain and sexual dysfunction are also associated with antidepressant use

• Reduce the seizure threshold (Wellbutrin/bupropion)

• Overdose can be fatal secondary to cardiac conduction disturbances

Selective serotonin reuptake inhibitors (SSRIs) purpose

block neuronal reuptake of serotonin and has minimal or no effect on reuptake or norepinephrine or dopamine. Increases serotonin.

Selective serotonin reuptake inhibitors common medications

• Prozax/Fluoxetine

• Zoloft/Sertraline

• Celexa/Citalopram

• Lexapro/Escitalopram

• Paxil/Paroxetine

• Luvox/Fluvoxamine

Selective serotonin reuptake inhibitors (SSRIs) nursing considerations

• Considered first-line treatment

• Can take up to 6-8 weeks to work

• Side effects: anxiety, agitation, akathesia, nausea/GI upset, cramping, sexual dysfunction

  • Serotonin syndrome: (excessive serotonin) diarrhea, restlessness, hyperrflexia, autonomic instability, extreme agitation, hyperthermia, seizures, delirium, coma, death

• Sudden stopping can cause discontinuation syndrome (withdrawal with flu like symptoms)

Serotonin norepeniphrine reuptake inhibitors (SNRIs) purpose

Increases both serotonin and norepinephrine

Serotonin Norepinephrine Reuptake inhibitors (SNRIs) nursing considerations

• Considered first line treatment

• Can take up to 6-8 weeks to work

• Side effects: most common are anxiety, agitation, akathesia, nausea/GI upset, cramping, sexual dysfunction. Hypertension may also be induced

  • Serotonin syndrome (excessive serotonin): diarrhea, restlessness, hyperreflexia, autonomic instability, extreme agitation, hyperthermia, seizures, delirium, coma, death

• Sudden stopping can cause discontinuation syndrome (withdrawal and flu like symptoms)